Neurological Disorders Q 60

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The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply.

  

     A. Increased appetite

     B. Vomiting

     C. Polydipsia

     D. Lethargy

     E. Head tilt

     F. Increased pulse

Correct Answer: B, D & E

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Head tilt, vomiting, and lethargy are classic signs assessed in a child with a brain tumor. Clinical manifestations are the result of location and size of the tumor. Tumors that develop in the brain are called primary tumors. Tumors that spread to the brain after forming in a different part of the body are called secondary tumors or metastatic tumors. This article focuses on primary tumors. There are more than 100 types of primary brain and spinal cord tumors.

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Option A: Increased appetite is not a sign of brain tumor. Seizures are the second most common symptom of presentation. The pathophysiology of seizures is attributed to tumor irritation to the cerebral cortex that leads to focal or generalized seizures. Other presenting symptoms of gliomas are tingling sensations, weakness, difficulty ambulation, and in rare cases, patients can present in a comatose state due to hemorrhage within the tumor which leads to an acute herniation syndrome.

Option B: The most common presentations in brain gliomas are headaches, nausea, vomiting, seizures, and in more advanced cases weakness or altered mental status. Other symptoms related to mass effects include nausea, vomiting, and change in vision.

Option C: Polydipsia is not found in a patient with a brain tumor. Symptoms that may be specific to the location of the tumor include changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum; or changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.

Option D: The neurological examination of these patients can be normal or present with different degrees of focal weakness, sensory deficits, or in a severe situation altered mental status due to an acute mass effect resulting from the tumor swelling.

Option E: Headaches are the most common initial presenting symptom of patients with glioma. The pathophysiology of headaches is theorized to be the result of tumor growth that places a mass effect on surrounding tissue. The mass effect, in turn, leads to pressure in the microvasculature and leads to edema. Depending on the location of the tumor in the brain, the mass effect leads to signs of a brain tumor.

Option F: Meningiomas present with typical brain tumor symptoms such as headaches, vision problems, or seizures. A headache–even a severe one–on its own is seldom a symptom of meningioma or any other brain tumor.

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